Long-term follow-up study and comparison of meso-atrial shunts and meso-cavo-atrial shunts for treatment of combined Budd-Chiari syndrome.

BACKGROUND

To investigate therapeutic effects of meso-atrial shunts (MASs) and meso-cavo-atrial shunt (MCASs) in combined Budd-Chiari syndrome (BCS).

METHODS

We retrospectively gathered 29 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC). Of them, 12 were treated with a MAS and 17 with a MCAS. We analyzed pre- and postoperative clinical symptoms, IVC, and portal venous (PV) pressure, occurrence rate of postoperative complications, patency rate of artificial vessels, and survival rate.

RESULTS

One patient in the MAS group died in the preoperative period. During the follow-up period from 3 d to 60 mo, 96.6% were included. The effective rates were 54% in MAS and 90.8% in MCAS. The occurrence rates of postoperative complications were 12.5% and 1.8%, respectively. The average decreases in IVC and PV pressure were 15.5 mm saline and 62.4 mm saline for MAS, and 12.3 mm saline and 184.7 mm saline for MCAS. The survival rates at 1, 3, and 5 y were 41.7%, 41.7%, and 16.7% for MAS, and 94.1%, 88.2%, and 82.4% for MCAS. The 5-y patency rates were 41.7% and 94.1%. Comparing these two groups, all of the studied factors, with the exception of PV pressure, were significantly different (P<0.05). Thus, the therapeutic effects of MCASs were better than those of MASs.

CONCLUSION

MCAS can simultaneously relieve high IVC and PV pressure in combined BCS. Compared with MASs, MCASs showed a decreased postoperative complication rate, a higher 5-y survival and artificial vessel patency rate.